Genetics' Role in the Healthcare of Patients - Assignment Example

?Genetics’ role in healthcare of patients: Ethics Genetic manipulation/ modification Genetic modification also called genetic engineering refers to the direct manipulation of an organism’s genome through the use of modern DNA technology. This process essentially involves the introduction of a foreign DNA into an organism. The introduction of new DNA into an organism does not require use of classic methods but traditional breeding methods are used for the propagation of recombinant organisms (Lemaux, 2006). The common form of genetic manipulation involves the insertion of new genetic material to a place that’s not specified in the host genome. This is done by isolating and copying the genetic material of interest by using molecular cloning methods in order to come up with a DNA sequence that contain the necessary genetic elements for expression. The construct is then inserted into the host organism. There exist other forms of genetic engineering such as gene targeting and knocking out of specific genes through engineered nucleases (Lemaux, 2006). Cloning though not considered genetic engineering or modification is closely related and genetic engineering has been seen to be used within it. Synthetic biology on the other hand is a discipline that is emerging where there is an introduction of artificially synthesized genetic material from raw materials into an organism. There are many resultants of genetic manipulations. When genetic materials from other species of organisms are added to a host the outcome is called a transgenic. When genes from same species that can interbreed are added to the result is a cisgenic. When genetic material is used to remove genetic material from another organism it results in a knockout organism (Lemaux, 2006). The process of genetic manipulation The first stage in genetic engineering is isolation of the gene. Here the gene that is supposed to be inserted into a host is identified, or chosen and then isolated form the others. The isolation process involves multiplying the gene using polymerase chain reaction and then inserted into a bacterial plasmid. The second stage is constructs where the isolated gene is combined with other genetic elements that are important for its functioning.in some cases the gene can be modified at this stage for effectiveness. The third stage is called gene targeting where the gene is inserted in the host genome. The most common technique for doing his is random placement. Other techniques involve placing the gene in specific locations. Gene targeting uses is known to use homologous recombination to target desired changes to a specified endogenous gene (Beardmore & Porter, 2003). The fourth stage is called transformation and this is where the DNA is moved into an organism thereby altering its genotype or genetic makeup. There are various types of transformations but the most common is the Microinjection-injecting the DNA directly into the cell nucleus using an ultrafine needle. The fifth stage is called selection where the transformed cells are differentiated from the untransformed cells. If a given cell has been transformed successfully it usually contains a marker gene. The selection is done by growing the cell in a chemical that marks the cells that express that gene. The sixth stage is called regeneration where the organism is grown from the single transformed cell. In plants it is done through tissue culture while in animals it is done in embryonic cells. The last stage is confirmation and this is where the organism is analyzed to ensure that the genes will be expressed in an appropriate manner in the tissues of the organism. All the above seven steps are followed for successful genetic manipulation (Beardmore & Porter, 2003). Genetic safety There are many safety concerns that are brought about by genetically modified organisms. This has made studies be undertaken in this area to ascertain the extent to which the genetically modified organisms are safe in our environment or are safe for our consumption or use. Argument for and against this issue are seen every day with many people against the idea of genetic engineering because of the safety. Genetically modified foods pose a huge problem people for consumers. These foods contain manipulated DNA that present some risk of hazard due to chemicals that might cause allergies in people who consume them. Other organic foods occurring naturally have the ability to affect people when consumed. Such foods have been known to cause allergies in people for example cow milk, eggs and fish. Genetically modified foods on the other hand pose higher risks of unique chemicals because of the modification of the naturally occurring DNA of the plants. Therefore there is need for adequate testing using to ascertain their safety before they are consumed. The best example here is the StarLink corn in the United States that was recalled after it was found to cause massive allergic reactions to people (Winter & Gallegos, 2006). A second possible safety concern is in the area of gene therapy. Studies have shown that gene therapy can be used in the treatment of certain diseases. It has been adopted in certain areas but rejected in other countries because of safety concerns. Current research in this area is evaluating its effectiveness and safety and in the future it will be able to discern whether it is effective treatment or not. Some already concluded studies have shown that there are very many serious health risks associated with gene therapy and these include the possibility of toxicity, inflammation and cancer. Because the technology is still evolving and new to researchers there are also unpredictable risks that pose risks to people (Akhtar, et al., 2011). The third possible risk occurs in the environment such that the introduction of GM crop varieties has uncertain impacts on the environment. One problem that has been noted is that the novel gene might unintentionally be transferred by pollination to other plants including weeds and other wild relatives of the crop species. Scientific studies have proved that this aspect is technically possible but the long term impacts are still yet to be established. There are fears that the transfers could lead to the development of resistant “super weeds”, the loss of genetic diversity and the possible destabilization of ecosystems. The last aspect is of great importance as potential safety concerns on people in the long term have been raised. Another safety issue has to do with germline genetic modification. The resulting child development may be altered due to the extensive manipulation of the stem cells, eggs, sperm or embryos in the laboratory. If the gene fails to be inserted in the right genome or becomes inserted and then fails to function, the resulting child will be worse off than they would have been without gene manipulation. Another risk is directed to the parents such that the germline genetic modification techniques that target ovaries or testes could damage those cells that give rise to mature eggs or sperm (Baruch, et al., 2005). Ethical and legal concerns a) Extrinsic concerns: These concerns are based on the doubts about the technology, its potentiality, newness and applicability to all life forms. The people in favour of technology think that genetic modification provides a great opportunity for solving hunger, food insecurity, and malnutrition in the world since it can be made for all environmental conditions and help in increasing quantity and quality of food. At the same time, there are fears raised about the safety of the food in eating and also risks to one’s health since it is considered as a new technology and people fear that some genes will be transmitted to them (Wertz, Fletcher, & Berg, 2003). There is a fear that GM crops and foods will result in the loss of our biodiversity. Also, since the technology is new and needs lots of investment, it would be unfair to small farmers in poor countries. These are valid concerns and demand scientific interventions. However, the scientific studies have not been conclusive; there may be benefits in some environments and societies and not in others. There have been reports both in favour and against genetic modifications which are confusing people (Wertz, Fletcher, & Berg, 2003). b) Intrinsic concerns: intrinsic concerns are based on how people view life, nature, religion, their personal emotions and values. There is a feeling that mixing up genes in the organisms for our use is "Playing God" and human beings should not intervene in God’s realm. Crossing natural species boundaries is creation of new life forms and inventing a new world through technology. Genetic engineering disrupts the beauty, integrity, balance of nature and might harm life. However, at the same time we can say that high tech medicine involves playing with God and agriculture was started by disrupting nature. Also hybrid plants and animals like mules are cross-species organisms and exist. In fact mules have been cloned and can reproduce in that way (Baruch, et al., 2005). Various legal concerns have arisen as a result of the aspect of genetic engineering. Many countries have banned some genetically modified organisms form their countries because of the many perceived risks associated with them. Some of them have not attempted to use these products because they lack the proper mechanisms for the testing and assessment to ascertain their safety. Most developing countries have not embraced the aspect of genetically modified organisms because of fear of potential effects (Baruch, et al., 2005). Another legal issue that has been raised is the issue of manipulation of the human gene. Cloning has been banned in most countries because of the ethical concerns that come with it as explained above. In the United States for example a fine of up to 1 million US dollars has been passed to be imposed on anyone engaging in cloning. Other countries accept this aspect such as in South Africa (Baruch, et al., 2005). Mandatory screening Genetic screening refers to the systematic search in a population for individuals that possess particular genotypes, which are either linked to disease, predispose individuals to disease or lead to disease in subsequent generations. It is an important public health measure because of the demand of healthcare information by many families that have affected members. There are many reasons for genetic screening and these include: medical management and treatment of the disease, the provision of reproductive information, for purposes of enumeration for future developments and research (Miller, 1999). Mandatory screening is compulsory for individuals and this is done in order that affected individuals can be treated and for the identification of carriers of recessive deleterious genes. A good example of this is the mandatory screening for PKU. There have been many legal and ethical concerns as a result of mandatory genetic screening. The debate that has been there for a long time is whether genetic screening should be an individual responsibility or the responsibility of the public health. Another concern is based on the disagreement of the necessity of the society to intervene in in the rights of the individual to procreate (Miller, 1999). The role of healthcare providers in gene therapy Gene therapy involves the genetic engineering f a patient’s genetic code to remove or replace a mutant gene that is causing a disease (Akhtar, et al., 2011). There exist two types of gene therapy germline or step cell that involves altering patient’s DNA in their reproductive cells. This is permanent and hereditary but very risky to be undertaken. The second is somatic gene therapy that involves engineering cells on a local basis without affecting the individual’s genetic blueprint. Gene therapy has played an important role in treating genetic disorders and certain diseases but as discussed earlier there are many safety issues and other ethical and legal issues that are involved (UN, 2002). Healthcare providers play an important role in gene therapy. First they must actively engage with their patients in a dialogue that will bring to their understanding all factors that will influence their choice of therapy. Many patients do not really understand the working mechanisms of gene therapy and therefore it is the role of a clinician to talk to them and find out how they their beliefs might impact on a given king of gene therapy. In the end the healthcare provider should provide various options to the patient that will be of benefit to them in line with their beliefs (Pipe, 2006). The second role is that of assessing the costs and benefits associated with a given gene therapy. There are many conditions that require gene therapy but these conditions may also remain relatively stable with normal treatments available. The introduction of gene therapy in such cases may only work to worsen the situation and therefore it is important that such issues are taken into consideration by weighing the pros and cons of the situation and advising the patient according on what is beneficial to them (Pipe, 2006). Another role that these health care providers play is that of genetic counseling. Before a patient undergoes gene therapy it is important that the practitioner prepares the individual psychologically explaining the various concerns that might arise. After the gene therapy it is also important that the patent is monitored continuously to help them in their recovery. This is the role of genetic counselors as these operations in gene therapy may have serious implications morbidity and mortality (Pipe, 2006). In conclusion, it has been seen that the process of genetic engineering is a complex process that follows given procedure in order to produce genetically modified organisms. The process possesses many safety issues ranging from individual to environmental. Ethical and legal concerns have also been identified as a result of genetic modification. There are various applications of genetic engineering especially in the healthcare industry. It has also been seen that genetic screening has come to play a role in society by identifying recessive genes and helping people in reproduction but ethical issues are still prevalent. The healthcare providers have an important role to play in making sure that people understand the various applications of genetic engineering in the health industry especially gene therapy as it affects the health of their patients to a large extent. References Akhtar, N., Akram, M., Asif, H. M., Usmanghani, K., Shah, S. M., Rao, S. A., et al. (2011). Gene Therapy: Areview Article. Journal of Medicinal Plants Research , 5(10)1812-1817. Baruch, S., Huang, A., Pritchard, D., Kalfoglou, A., Javitt, G., Borchelt, R., et al. (2005, May). Human Germline Genetic Modification: Issues and Options for Policymakers. Retrieved Novemeber 30, 2011, from Genetics and Public Policy center: http://www.dnapolicy.org/images/reportpdfs/HumanGermlineGeneticMod.pdf Beardmore, J. A., & Porter, J. S. (2003). Genetically Modified Organisms and Aquaculture. Retrieved Novemeber 30, 2011, from Food and AGricultural organization: ftp://ftp.fao.org/docrep/fao/006/y4955e/Y4955E00.pdf Lemaux, P. G. (2006). Introduction to genetic Modification. Carlifornia series, 8178: 1-5. Miller, K. (1999). Genetic Screening. Retrieved Novemeber 30, 2011, from North Dakota State University: http://www.ndsu.edu/pubweb/~mcclean/plsc431/students99/miller.htm Pipe, S. W. (2006). The physician's role in selecting a factor replacement therapy. Haemophilia, 12(s1): 21-25. UN. (2002). Key Issues in Biotechnology. UN Conference on Trade and Development (pp. 9-10). New York and Geneva: United Nations. Wertz, D., Fletcher, J., & Berg, K. (2003). Review of Ethical Issues in Medical Genetics. Geneva: WHO. Winter, K., & Gallegos, L. K. (2006). safety of Genetically Modified Foods. Retrieved November 30, 2011, from University of Carlifornia: http://ucanr.org/freepubs/docs/8180.pdf Read More